Assignment

Assignment

Introduction

Optimal target blood glucose and the best way to control blood glucose is currently pending for adult patients in critical condition. Although intensive insulin therapy (IIT, control of blood glucose to blood glucose levels from 4,4 to 6,1 mmol / l) increase in mortality and morbidity among adults in the critically ill and surgical patients in 2 randomized controlled trials, 1,2 in IIT favor of the respondents in the last three studies3-5 and one meta-analysis. Fears of severe hypoglycemia events related to the implementation of IIT have been another reason to advise on the implementation of the ITI and agree with the higher blood glucose goals , thus potentially losing the benefits associated with IIT. Other factors potentially affecting the implementation of the ITI may include the belief that this strategy is time consuming and costly, and lack of common guidelines for the light.

Understanding the current blood glucose management model in practice and beliefs, and concerns relating to the control of blood glucose levels, in particular, IIT is a necessary condition for the development of (inter) national level, adopted guidelines for the control of blood glucose in adult patients in critical condition. We suggest that IIT is not implemented in critically ill patients in the Netherlands, and if implemented, that it differs substantially from the guideline. Study population

A questionnaire was sent ICU physicians and / or ICU nurses in the Netherlands. Neonatal and pediatric ICUs were excluded from the study. Medical services to all adults ICU were contacted and asked to nominate a physician, intensive care and / or an intensive care nurse working control of blood glucose to fill out a questionnaire, after which the participants were contacted. Discussion

In this review, on blood glucose control and ITI, we have shown is true but incomplete implementation of IIT in the ICU in the Netherlands. Indeed, while nearly half of the ICUs reported that they used the IIT and the fast majority stated that the management of glucose control, insulin was initiated at much higher values of glucose in the blood than in the original study Van den Berghe et al . al. In addition, unlike research, Leuven, insulin was started and the dose adjusted, and medical intensive care and intensive care nurses, not ICU nurses alone.

Nurses ICU (and never intensive care doctors, who actually banned the control of blood glucose in Leuven), c) measurement of glucose in the blood, which should be performed at specified time points (eg, every four hours, but measurements can be made in between appropriate; decision is left to the discretion of the nurse attending ICU), d), although severe hypoglycemia is clearly stated as being potentially dangerous side effects (mild) hypoglycemia is not grounds for termination of insulin and glucose pouring, but the basis for more thorough and take more frequent measurements of blood glucose to adjust the insulin dose when the risk of severe hypoglycemia increases or persists.

This study clearly shows that these aspects are not transferred to the currently used ...